tbuckley/cabot-search huggingface dataset:
Abstract 10746: Association of Left Ventricular Relative Wall Thickness With Thromboembolism in Non-Valvular Atrial Fibrillation Patients With or Without Hypertension: The Fushimi Af Registry
Authors: Yuji Tezuka, KOSUKE DOI, Yasuhiro Hamatani, Mitsuru Ishii, Moritake Iguchi, Nobutoyo Masunaga, Masahiro Esato, Hiromichi Wada, Koji Hasegawa, Hisashi Ogawa, Mitsuru Abe, Masaharu Akao
Journal: Circulation (2022)

Introduction: Hypertension (HT) is the main cause of atrial fibrillation (AF) and left ventricular (LV) hypertrophy. Meanwhile, LV hypertrophy can be also the manifestation of some cardiomyopathies. We reported that increased LV relative wall thickness (RWT) was associated with the incidence of thromboembolism events (TE) in patients with non-valvular AF (NVAF). We investigated the association of RWT with TEs in NVAF patients with or without HT. Methods: In the Fushimi AF Registry, follow-up data were available for 4,489 patients. Of them, RWT values at enrollment were available for 3,408 patients with NVAF (with HT: n=2,159, without HT: n=1,249). We investigated the relationship between each RWT quartile and the incidence of TEs. Results: During the median follow-up period of 1,838 days, 297 TEs occurred. Regardless of the coexistence of HT, higher RWT groups had higher CHA 2 DS 2 -VASc score and higher HELT-E 2 S 2 score and the prescription of oral anticoagulants were comparable among the four groups. The incidence of TEs according to the groups stratified by each RWT quartile with or without HT is shown (Figure). In the multivariate analysis, higher RWT was independent predictors of TEs in the patients with or without HT (Table). The incidence rate of TEs were comparable between RWT&gt;0.6 patients with HT and without HT (2.11 vs. 2.73% per patient-year, log-rank; p=0.67), whereas the patients with HT had higher CHA 2 DS 2 -VASc and HELT-E 2 S 2 scores. Conclusions: RWT was independently associated with the incidence of TEs among Japanese patients with NVAF regardless of the concomitance of HT.
Abstract 10755: Association Between Weight Loss and Prognosis in Patients With Atrial Fibrillation: The Fushimi AF Registry
Authors: Moritake Iguchi, Yasuhiro Hamatani, Nobutoyo Masunaga, Mitsuru Ishii, Yuya Ide, Akiko Fujino, Takashi Yoshizawa, KOSUKE DOI, Syuhei Ikeda, Kenjiro Ishigami, Kimihito Minami, Yumiko Nakanishi, Masahiro Esato, Hiromichi Wada, Koji Hasegawa, Hisashi Ogawa, Mitsuru Abe, Masaharu Akao
Journal: Circulation (2022)

Background: Weight loss is one of the key factors of frailty, and we previously reported that low body weight (≤50 kg) was associated with higher mortality and morbidity in patients with atrial fibrillation (AF). However, the association of weight loss with prognosis in AF patients is unclear. Methods: From the Fushimi AF registry, 2,523 patients with data on changes in body weight at 1 year after enrollment and follow-up data after 1 year were included in the analysis. We defined weight loss as changes in body weight ≤-4.5 kg based on the frailty-defining criteria in the Cardiovascular Health Study. Results: At 1 year after enrollment, 273 (10.8%) patients had weight loss. Mean body weight (changes) at 1 year in patients with and without weight loss were 58.8±14.1 (-8.7±5.8) and 60.7±13.1 (0.7±3.4) kg, respectively (P=0.03). Patients with weight loss were more likely to be male, and had more heart failure, diabetes and chronic kidney disease at baseline. Age and prevalence of prior stroke/systemic embolisms (SE) were similar between the groups, but patients with weight loss had higher incidence of heart failure hospitalization (12.5% and 4.7%) and stroke/SE (4.8% and 2.2%) before 1-year follow-up. Landmark analysis after 1 year revealed that patients with weight loss showed significantly higher incidence of all-cause death and cardiac death (Figure A), but not stroke/SE or major bleeding. Incidence of heart failure hospitalization tended to be higher in patients with weight loss, but not statistically significant. Patients with weight loss also showed higher all-cause and cardiac mortality even in those without low body weight (Figure B). After adjustment for clinical confounders, weight loss was significantly associated with the incidence of all-cause death (hazard ratio, 1.79; 95% confidence interval, 1.43-2.21). Conclusion: In AF patients, weight loss was significantly and independently associated with higher all-cause mortality.
Abstract 10480: Depression and Coronary Artery Disease Share Genetic Risk Factors Enriched in Inflammation and Cardiomyopathy-Associated Pathways
Authors: Kritika Singh, Tyne W Miller-Fleming, Hyunjoon Lee, Julia M Sealock, Daniel E Gustavson, Jordan W Smoller, Lea Davis
Journal: Circulation (2022)

Coronary artery disease (CAD) and depression are highly prevalent (7% and 8% respectively), comorbid diseases. Approximately 40% of adults who are initially diagnosed with either CAD or depression will also develop the other condition. We have observed that the polygenic risk scores for depression were significantly associated with CAD in a large hospital population even in patients without any psychiatric diagnoses and after adjusting for known CAD risk factors. This suggests that some proportion of genes that increase susceptibility to depression act pleiotropically to increase CAD risk. To identify the genes increasing risk for both CAD and depression we performed a cross-tissue S-MultiXcan analysis on the summary statistics for CAD (CARDIoGRAMplusC4D Consortium) and depression (PGC and UK Biobank). We identified 185 genes associated with both depression and CAD, representing a three-fold enrichment of shared associations ( P value &lt;1.718e-43). Next we performed a pathway enrichment analysis and observed that these genes were enriched for inflammation and cardiomyopathy-associated pathways. We then used electronic health records at Vanderbilt, to test the prevalence of cardiomyopathy in patients with comorbid depression and CAD. We found that the depression-CAD cohort had a significantly increased prevalence of cardiomyopathy diagnoses ( OR = 1.27, 95%C.I. = 1.17-1.30, P value = 3.69 e-9) compared to patients with CAD after we controlled for Type 2 Diabetes, hypertension, smoking and median BMI. We replicated these findings across two external cohorts - All of Us and Massachusetts General Hospital health records. Using a Genomic structural equation model (GSEM), we observed that inflammatory markers white blood cell (WBC) count and platelet count explained 1% and 16% of the SNP-based genetic correlation between depression and CAD, respectively in a single factor. The mediation paths models using the summary statistics data show that WBC and platelets mediate approximately 1% and 13% of comorbidity and together explain 14.4% of the total genetic correlation between depression-CAD. These results highlight cardiomyopathy and inflammation as an important biological link in the comorbid manifestation of CAD and depression.
Abstract 10570: Inflammation During Early Post-Acute Covid-19 is Associated With Reduced Exercise Capacity and Long Covid Symptoms After 1 Year
Authors: Matthew S Durstenfeld, Michael J Peluso, Punita Kaveti, Christopher Hill, Danny Li, Erica Sander, Shreya Swaminathan, Victor M Arechiga, Kaiwen Sun, Yifei Ma, victor zepeda, Scott Lu, Sarah A Goldberg, Rebecca Hoh, Ahmed Chenna, Brandon C Yee, JOhn W Winslow, christos J petropoulos, Sithu Win, JOHN D KELLY, David V Glidden, Timothy J Henrich, Jeffrey N Martin, Yoo Jin Lee, Mandar A Aras, Carlin S Long, Donald J Grandis, Steven G Deeks, Priscilla Y Hsue
Journal: Circulation (2022)

Introduction: Mechanisms underlying cardiopulmonary symptoms following SARS-CoV-2 infection (post-acute sequelae of COVID-19 “PASC” or “Long COVID”) remain unclear. The purpose of this study was to elucidate the pathophysiology of PASC using cardiopulmonary exercise testing (CPET), cardiac magnetic resonance imaging (CMR) and ambulatory rhythm monitoring. Methods: We performed CMR, CPET, and ambulatory rhythm monitoring among adults &gt; 1 year after confirmed SARS-CoV-2 infection in the UCSF Long-Term Impact of Infection with Novel Coronavirus cohort (LIINC; NCT04362150) and correlated findings with previously measured biomarkers. We used logistic regression to estimate associations with PASC symptoms and linear regression to estimate differences by symptoms adjusted for confounders. Results: Out of 120 participants, 46 participants (unselected for symptom status) had cardiac testing performed at median 17 months after infection. Median age was 52, 18 (39%) were female, and 6 (13%) were hospitalized for severe acute infection. On CPET (n=39), 13/23 (57%) with symptoms had reduced exercise capacity (peak VO2&lt;85% predicted) compared to 2/16 (13%) without symptoms (p=0.008). Adjusted peak VO 2 was 5.9 ml/kg/min lower (-9.6 to -2.3; p=0.002) or -21% predicted (-35 to -7; p=0.006) among those with symptoms. Chronotropic incompetence was present among 9/15 (60%) with reduced peak VO2 (adjusted heart rate reserve&lt;80%: OR 15.6 for reduced peak VO2, 95%CI 1.30-187; p=0.03). Inflammatory markers (hsCRP, IL-6, TNF-α) and SARS-CoV-2 antibody levels measured early in PASC (median 3.5-6 months after infection) were negatively correlated with peak VO2 more than 1 year later (Figure). Conclusions: Cardiopulmonary symptoms and elevated inflammatory markers present early in PASC are associated with reduced exercise capacity during CPET &gt;1 year following COVID-19. Chronotropic incompetence may explain reduced exercise capacity among some individuals with PASC.
Abstract 10423: US Counties With Low Broadband Internet Access Have a High Burden of Cardiovascular Risk Factors, Disease, and Mortality
Authors: Aaron Troy, Jiaman Xu, Rishi Wadhera
Journal: Circulation (2022)

Introduction: Nationwide broadband internet access is a major federal priority. The bipartisan infrastructure law invested $65 billion into equitable broadband expansion, driven by concern that broadband access is a social determinant of health. However, the difference in health outcomes between counties with low vs. higher broadband access has not been studied, and could provide insights on the implications of expansion efforts. Objectives: We evaluated demographic factors, health resources, and cardiovascular disease (CVD) burden in counties with low broadband access compared to those with higher access. Methods: We assessed all 3,142 US counties in 2019 and identified those with low broadband access, defined as &lt;50% of residents having access to internet subscriptions with speeds &gt; 25 Mbps download / &gt; 3 Mbps upload, using the US Broadband Usage Percentages Dataset. We linked these data to the American Community Survey, American Health Resource File, PLACES, and CDC WONDER for demographic, health resource, CVD risk factor and outcomes, and mortality data respectively. Results: There were 461 counties with low broadband access and 2,650 counties with higher access. Compared to those with higher broadband access, counties with low broadband access had lower high school graduation rates (47% vs 54%, p&lt;0.001) and were more likely to be rural (86% vs 59%, p&lt;0.001). Low-access counties had fewer primary care physicians and fewer cardiologists, but similar hospital beds per capita ( Table ). These counties had higher rates of CVD risk factors, coronary artery disease, and stroke, as well as higher age-adjusted rates of CVD mortality and all-cause mortality ( Table ). Conclusions: Counties with low broadband access have lower access to physicians and significantly higher rates of CVD risk factors, CVD, and CVD mortality. Expanding access to broadband internet and telemedicine has the potential to improve access to care and reduce disparities in CVD outcomes.
Abstract 10416: Influenza Vaccine Among Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Studies
Authors: Mohamed Hamed, MAHMOUD ABDELSALAM, Hesham Abowali, Karim Al-Azizi, Mohan Rao, Hani Jneid, Wissam Khalife, Ayman Elbadawi
Journal: Circulation (2022)

Introduction: Trials evaluating the efficacy of influenza vaccine in secondary prevention among patients with prior coronary artery disease (CAD) have yielded mixed results. We sought to evaluate the efficacy of influenza vaccine in reducing cardiovascular events among patients with prior CAD. Methods: MEDLINE, EMBASE, and Cochrane databases were searched without restrictions through March 2022 for Randomized Controlled Trials (RCTs) that evaluated the outcomes of influenza vaccine versus control in patients with prior CAD. We conducted a pairwise meta-analysis comparing outcomes among the influenza vaccine. The primary outcome was all-cause mortality. Results: The final analysis included 5 trials with a total of 4,187 patients and the weighted median follow-up duration was 12 months. The influenza vaccine group was associated with 46% relative risk [RR] reduction in all-cause mortality compared with control group. (2.8% vs. 5.1%; RR 0.56; 95% confidence interval [CI] 0.41-0.76; I 2 =0%). The influenza vaccine group was also associated with lower composite of MACE (6.3% vs. 9.9%; RR 0.63; 95% CI 0.52-0.78), and cardiovascular mortality (2.5% vs. 4.7%; RR 0.54; 95% CI 0.39-0.74). There was no significant difference among both groups in acute myocardial infarction (MI) (RR 0.77; 95% CI 0.53-1.13), ischemia—driven revascularization (RR 0.89; 95% CI 0.52-1.53) and hospitalization for heart failure (RR 0.91; 95% CI 0.91 0.21-4.00). Conclusion: a meta-analysis of RCTs showed that influenza vaccine was associated with lower major adverse cardiac events (MACE), all-cause mortality, and cardiovascular mortality in patients with prior CAD. Further efforts are warranted to improve influenza vaccination rate in patients with CAD.
Abstract 10253: Integrating Mental Health Screening Into a Health System for Measurement-Based Care of Patients With Peripheral Artery Disease
Authors: Lindsey Scierka, Carlos Mena-Hurtado, Gaelle Romain, Jeremy A Provance, Brooklyn Bradley, Shannon Lynch, Alexandria Bascombe, Waleed Tariq Siddiqui, Mufti Rahman, Pragati Bogra, Evy van Roij, Sameer Nagpal, Francine Lorusso, Eric J Velazquez, Keith B Churchwell, Kim G Smolderen
Journal: Circulation (2022)

Introduction: Multi-dimensional assessments of patient reported outcomes (PROs) are becoming increasingly important in optimizing patient-centered care for chronic conditions such as peripheral artery disease (PAD). We aimed to demonstrate the feasibility of a health system integrated workflow to incorporate mental health screenings into the outpatient PAD clinic workflow. Methods: In a large academic center, we administered three validated psychological assessments to consecutive outpatients between March 3, 2021 and July 7, 2021. Assessments were administered as part of an in-person patient navigation system (Yale PRO-QI) and was supported by online data collection. Assessments included the Patient Health Questionnaire-8 (PHQ-8) for depression, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety, and the Perceived Stress Scale-4 (PSS-4) for stress. Validated cutoffs were used to screen for depression and anxiety ( &gt; 10 = depression or anxiety, respectively) and stress (&gt;6 = high stress). Results: There were 104 assessments collected for 98 participants with a mean age of 68.6 + 12.0 years old, 38.8% female, 86.7% White, 9.1% Black and 2.0% Asian or American Indian. The majority (72.5%) were seen for a routine follow-up visit. Two participants (2.0%) screened positive for generalized anxiety disorder. For depression, 12.2% screened positive. Almost half of all participants (47.9%) had higher levels of stress compared with a normative population. There were no statistically significant associations between the risk of positive screening and visit type. Conclusions: Measurement-based care metrics are becoming a standard best practice in routine clinical operations. Psychosocial screening instruments can be integrated in PAD outpatient care and highlight opportunities to improve integrated behavioral care pathways to provide the best care for this vulnerable population.
Abstract 10864: Reduction in Right Ventricular Strain is Associated With Increased Mortality in Acute Pulmonary Embolism
Authors: Shunsuke Eguchi, Michael Pfeiffer, Brandon Peterson, Mohammed Ruzieh, Zhaohui Gao, John Boehmer, John Gorcsan, Ryan Wilson
Journal: Circulation (2022)

Introduction: Right ventricular (RV) systolic dysfunction has been identified as a prognostic marker for adverse clinical events in patients presenting with acute pulmonary embolism (PE). However, problems exist in identifying RV dysfunction using conventional echocardiography. Strain echocardiography is an evolving imaging modality which measures myocardial deformation and can be used as an objective index of RV systolic function. Hypothesis: We hypothesized that RV strain analysis is prognostic of mortality in patients with acute PE. Methods: Retrospective cohort study of 177 patients with acute PE between 2010 and 2017. Strain analysis was retroactively applied. All echocardiograms were completed within 48 hours of diagnosis. RV global longitudinal strain (RVGLS) was applied using TomTec®. The primary outcome was all-cause mortality at 30 days and in-hospital mortality. T-test statistical analysis was performed. Receiver operating characteristic (ROC) curves and Kaplan-Meier curves were used for evaluation. Results: Study quality was sufficient to perform RVGLS analysis in 157 patients (90.2%). Mortality at 30 days and in-hospital mortality occurred in 12.7% and 8.9% of patients respectively. Comparing 30-day mortality, there was a significant reduction in RVGLS compared to survivors (13.0% ± 3.0% vs 19.6% ± 3.5%, p &lt; 0.001). In-hospital mortality as well showed a significant difference (13.1% ± 3.3% vs 19.3% ± 3.7%, p &lt; 0.001). Using ROC curves, we chose a RVGLS value of 17.5% (sensitivity 90%, specificity 74%) to predict 30-day mortality. Patients with RVGLS worse than 17.5% had 18 times higher risk of 30-day mortality compared to patients with RVGLS better than 17.5% (HR 18.4, 95% CI= 4.2-79.7, p &lt; 0.001. Figure). Conclusions: RV strain have significant prognostic value in patients with acute PE, and identifying those at higher risk of death. Assessment of RV strain has promise for clinical applications.
Abstract 10131: Real World Comparative Outcomes From Left Atrial Appendage Occlusion versus Anticoagulation Among Females and Males
Authors: Emily P Zeitler, Stephen Kearing, Megan Coylewright, Devi Nair, Jonathan C Hsu, Douglas Darden, James O'Malley, Sana M Al-Khatib
Journal: Circulation (2022)

Introduction: Clinical decision-making around AF-related stroke risk management is complicated by the widely available and safe direct acting oral anticoagulants (AC) and uncertain long term risks of left atrial appendage occlusion (LAAO) in patients who are older and more female than clinical trial participants. Hypothesis: Among matched sex-stratified Medicare beneficiaries with AF, there is no difference in risk of mortality, stroke, and bleeding associated with LAAO versus AC alone. Methods: Medicare beneficiaries with AF and CHA2DS2VASc of 2 (males) or 3 (females) (2015-2019) were divided into those who underwent LAAO or received AC only. LAAO and AC patients were propensity score matched 1:1 within sex subgroups based on available characteristics. A Cox proportional hazards model was used to model the survival time from the LAAO implant date to evaluate the comparative risks of mortality, stroke/thromboembolism, and any bleeding events based on ICD-10 codes. Results: Matching sex-stratified AC and LAAO patients was successful (SMD &lt; 10% on all variables). Average follow-up was 1 year. Among females (n=4,085; mean 76 years, CHA2DS2VASc 5.1), LAAO was associated with reduced risk of mortality and stroke/thromboembolism (HR 0.51 95% CI 0.45-0.58; HR 0.66 95% CI 0.56-0.77, p&lt;0.0001) compared with AC; similar findings were observed among males (n=5,378; mean 75.3 years, CHA 2 DS 2 VASc 4.1) regarding mortality and stroke/ thromboembolism (HR 0.54 95% CI 0.49-0.60; HR 0.65 95% CI 0.55-0.76, p&lt;0.0001). Comparative bleeding risk varied over time with LAAO associated with greater risk early then lesser risk (females HR 1.03 95% CI 0.92-1.16; males HR 1.05 95% CI 0.95-1.17). (Figure) Conclusion: Within sex subgroups during an average of 1 year follow up, LAAO was associated with a reduced risk of mortality and stroke/thromboembolism when compared with AC alone among Medicare beneficiaries with AF. There was no difference in the risk of bleeding between LAAO and AC groups.
Abstract 10215: Investigating Aortic Geometric Changes After Endovascular and Open Surgery Repair of Descending Thoracic Aortic Aneurysms
Authors: Hannah Cebull, Andy Dong, Leonardo Molinari, Alessandro Veneziani, Bradley G Leshnower, Marina Piccinelli
Journal: Circulation (2022)

Introduction: Repair of descending thoracic aortic aneurysms (DTAA) by endovascular (TEVAR) or open aortic replacement alters aortic anatomical and biomechanical characteristics, which may result in adverse cardiac remodeling. The interplay between all these factors remains mostly unknown. Hypothesis: A robust and objective quantification of 3D geometrical changes to the treated aorta will help investigate long-term cardiovascular consequences of DTAA repair. Methods: Pre- and post-operative 3D modeling from CT angiography was obtained for 6 patients undergoing OPEN (n=3) or TEVAR (n=3). An automated analysis was conducted to extract aorta centerlines, register pre/post geometries based on anatomical landmarks, calculate the following features: length ( L ), curvature ( C ), torsion ( T ), tortuosity ( TT ), cross sectional area ( A ), and volume ( V ). Pre/post repair geometric analysis was conducted on the ascending (AscAo) and descending (DesAo) aorta, and in consecutive segments based on C / T profiles; rotations between segments modeled as osculating planes were calculated; TEVAR vs OPEN differences were investigated. Results: The age of patients was 65±15 years and 4 were female. All centerline and geometric features were calculated from the models. Fig 1 shows one case with registered C profiles. Main results between pre/post were: increase in A AscAo (mean 43.4±20.5 mm 2 ) and V AscAo (mean 31.3±9 cm 3 ); increase in TT DesAo (0.6±0.4 vs 1.4±0.5, p=0.01); TEVAR cases showed DesAo elongation (mean 17.8±4 mm); trends for increasing C max (AscAo) and decreasing C max (DesAo); inter-segment rotations show notable pre/post variations (Fig 1b). Conclusions: Our preliminary analysis automatically quantified relevant changes in aortic anatomy pre/post repair of DTAA with either open or endovascular repair. Complemented with fluid dynamics and biomechanical studies these investigations could clarify mechanisms affecting long-term consequences of DTAA repair.